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Therapies
Sous presse. Epreuves corrigées par l'auteur. Disponible en ligne depuis le mercredi 26 octobre 2016
Doi : 10.2515/therapie/2015049
Received : 6 June 2015 ;  accepted : 10 July 2015
Prescription errors by emergency physicians for inpatients are associated with emergency department length of stay
Les erreurs de prescriptions des urgentistes sont associées à la durée de séjour aux urgences
 

Pierre-Géraud Claret a, b, , Xavier Bobbia a, Rhoda Renia a, Andrew Stowell a, Jacques Crampagne a, Jean Flechet a, Christian Czeschan c, Mustapha Sebbane a, Paul Landais b, d, Jean-Emmanuel de La Coussaye a
a Pôle anesthésie réanimation douleur urgences, centre hospitalier universitaire de Nîmes, 4, rue du Professeur-Robert-Debré, 30029 Nîmes, France 
b EA 2415, Clinical Research University Institute, centre hospitalier universitaire de Montpellier, 34000 Montpellier, France 
c Département informatique médicale, centre hospitalier universitaire de Nîmes, 30029 Nîmes, France 
d Département de biostatistique, épidémiologie, santé publique et informatique médicale, centre hospitalier universitaire de Nîmes, 30029 Nîmes, France 

Corresponding author. Pôle anesthésie réanimation douleur urgences, centre hospitalier universitaire de Nîmes, 4, rue du Professeur-Robert-Debré, 30029 Nîmes, France.
Summary
Objectives

Adverse drug events are the sixth-leading cause of death in Western countries and are also more frequent in emergency departments (EDs). In some hospitals or on some occasions, ED physicians prescribe for patients who they have admitted. These prescriptions are then followed by the wards and can persist for several days. Our objectives were to determine the frequency of prescription errors for patients over 18years old hospitalized from ED to medical or surgical wards, and whether there exists a relationship between those prescription errors and ED LOS.

Methods

This was a single center retrospective study that was conduct in the ED of a university hospital with an annual census of 65 000 patients. The population studied consisted of patients over 18years old hospitalized from ED to medical or surgical wards between January 1st, 2012 and January 21st, 2012.

Results

Six hundred eight patients were included. One hundred fifty-four (25%) patients had prescription errors. Prescription errors were associated with increased ED length of stay (OR=2.47; 95% CIs [1.58; 3.92]) and polypharmacy (OR=1.78; 95% CIs [1.20; 2.66]). Fewer prescription errors were found when the patient was examined in the ED by a consultant (OR=0.61; 95% CIs [0.41; 0.91]) and when the medical history was known (OR=0.28; 95% CIs [0.10; 0.88]).

Conclusion

Prescription errors occurred frequently in the ED. We assume that a clear communication and cooperation between EPs and consultants may help improve prescription accuracy.

The full text of this article is available in PDF format.
Résumé
Objectifs

Les effets secondaires indésirables des médicaments, sixième cause de décès dans les pays occidentaux, sont fréquents aux urgences. Dans certains hôpitaux, les urgentistes prescrivent pour les patients qu’ils hospitalisent. Ces prescriptions peuvent perdurer plusieurs jours. Notre objectif principal était d’observer la fréquence des erreurs de prescriptions pour ces patients hospitalisés à partir des urgences.

Méthodes

Étude monocentrique rétrospective. La population étudiée correspondait à l’ensemble des patients, admis aux urgences puis hospitalisés en médecine ou en chirurgie, du 1er janvier au 21 janvier 2012.

Résultats

Six cent huit patients ont été inclus, 154 (25 %) avaient des erreurs dans leurs prescriptions. Les erreurs de prescriptions étaient associées à une plus grande durée de séjour (OR=2,47 ; IC 95 % [1,58 ; 3,92]) et à une polymédication (OR=1,78 ; IC 95 % [1,20 ; 2,66]). Moins d’erreurs étaient associées à une consultation aux urgences par un spécialiste (OR=0,61; IC 95% [0,41 ; 0,91]) ou la connaissance des antécédents du patient (OR=0,28; IC 95% [0,10 ; 0,88]).

Conclusion

Les erreurs de prescriptions surviennent fréquemment aux urgences. Nous pensons que de meilleure communication et collaboration entre médecins urgentistes et consultants peuvent améliorer la justesse des prescriptions.

The full text of this article is available in PDF format.

Keywords : Emergency service, Hospital, Length of stay, Medication errors, Drug therapy

Mots clés : Structure d’urgences, Durée de séjour, Erreurs médicamenteuses, Traitement médicamenteux




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